title: Tumour necrosis factor blocking agents and progression of subclinical atherosclerosis in patients with ankylosing spondylitis.
abstract: BACKGROUND
  Ankylosing spondylitis (AS) is associated with an increased cardiovascular risk that might be due to the chronic underlying inflammatory process. We investigated whether subclinical atherosclerosis of the carotid artery in patients with AS was reduced after anti-inflammatory treatment with tumour necrosis factor (TNF) inhibitors in a prospective observational cohort study.
  
  
  METHODS
  67 out of 81 AS patients who used TNF inhibitors and underwent ultrasonography at baseline returned for follow-up after 4.9 years. Of all patients, 12 (15%) discontinued the use of TNF inhibitors. Assessments of medication use, AS-related factors and cardiovascular risk factors were measured at baseline and repeated at follow-up. B-mode carotid ultrasonography was used to investigate arterial wall parameters, including carotid intima-media thickness (cIMT) and Young's elastic modulus (YEM).
  
  
  RESULTS
  After a median 4.9 years of follow-up, cIMT did not change significantly (paired t test +0.011 mm, p=0.561) in those who continued the use of TNF inhibitors, while cIMT increased substantially (+0.057 mm, p=0.069) in those who did not continue their use of TNF inhibitors. The effect of TNF inhibitors was mainly mediated by a subsequent decrease in AS disease activity. Vascular elasticity (as measured with YEM) did not change significantly in patients who discontinued TNF inhibitors or those who continued TNF inhibitors.
  
  
  CONCLUSIONS
  The use of TNF inhibitors might stabilise or slow down the progression of subclinical atherosclerosis in AS patients, reflecting a decreased cardiovascular risk in these patients.
authors.affiliation: Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands Department of Internal Medicine, Institute for Cardiovascular Research (ICAR), VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Alper M
authors.initials: AM
authors.lastname: van Sijl
authors.affiliation: Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Izhar C
authors.initials: IC
authors.lastname: van Eijk
authors.affiliation: Department of Internal Medicine, Institute for Cardiovascular Research (ICAR), VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Mike J L
authors.initials: MJ
authors.lastname: Peters
authors.affiliation: Department of Internal Medicine, Institute for Cardiovascular Research (ICAR), VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Erik H
authors.initials: EH
authors.lastname: Serné
authors.affiliation: Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Irene E
authors.initials: IE
authors.lastname: van der Horst-Bruinsma
authors.affiliation: Department of Internal Medicine, Institute for Cardiovascular Research (ICAR), VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Yvo M
authors.initials: YM
authors.lastname: Smulders
authors.affiliation: Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands Department of Internal Medicine, Institute for Cardiovascular Research (ICAR), VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Nurmohamed
mesh_terms: D000068879:Adalimumab; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D058070:Asymptomatic Diseases; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D015331:Cohort Studies; D018450:Disease Progression; D055119:Elastic Modulus; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012307:Risk Factors; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D059289:Vascular Stiffness
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D000068800:Etanercept
keywords: Ankylosing Spondylitis; Atherosclerosis; Cardiovascular Disease; TNF-Alpha; Ultrasonography